A nurse is assessing a 1-month-old infant at a pediatric office. Which of the following findings requires a referral for further care?

Rationale for correct choices:

• A change in mood: Isotretinoin is associated with serious neuropsychiatric side effects, including depression, mood swings, and suicidal ideation. Adolescents are particularly vulnerable, and any mood changes should be reported immediately to prevent potential harm.
• Decreased night vision: Isotretinoin can cause visual disturbances, including impaired night vision, which may develop suddenly and without warning. This adverse effect can pose safety risks, especially when driving or navigating in low-light conditions, and requires prompt provider evaluation.

Rationale for incorrect choices:

• Dry mouth: Dry mucous membranes are a common and expected side effect of isotretinoin due to its drying effects on the skin and mucosa. While it may cause discomfort, it is not typically urgent or dangerous unless accompanied by other systemic symptoms.
• The development of dry eyes: Dry eyes are a frequent and expected adverse effect of isotretinoin. This symptom can usually be managed with artificial tears or lubricating eye drops and does not require immediate provider notification unless severe or worsening.
• Sunburn: Isotretinoin increases photosensitivity, making clients more prone to sunburn. However, this is a manageable and anticipated side effect. The client should be advised to use sunscreen and protective clothing rather than treat it as an emergency.
• Engagement in sexual activity: Sexual activity becomes relevant only if pregnancy is a risk, due to isotretinoin’s severe teratogenicity. Since the client currently tests negative on hCG and is not sexually active, it is not a priority concern unless that status changes.
• Worsening of acne: A temporary worsening of acne, known as an initial flare, is common in the first few weeks of isotretinoin therapy. It is not considered dangerous and does not warrant immediate discontinuation or urgent evaluation unless accompanied by severe systemic symptoms.

Rationale:

A. Diabetes screening: Screening for diabetes is a form of secondary prevention, aimed at early identification and intervention to prevent disease progression in asymptomatic individuals.

B. Nutrition counseling: Nutrition counseling is a primary prevention strategy when used to promote health and prevent disease. It aims to reduce risk factors before illness occurs.

C. Family planning: Family planning falls under primary prevention as it involves proactive measures to prevent unintended pregnancies and support reproductive health.

D. Physical therapy: Physical therapy is a tertiary prevention measure focused on reducing the impact of an existing disease or injury. It helps restore function, prevent further disability, and improve quality of life in individuals with chronic or advanced conditions.